Estimating the Hospital Burden of Norovirus-Associated Gastroenteritis in England and Its Opportunity Costs for Nonadmitted Patients

Frank G. Sandmann*, Laura Shallcross, Natalie Adams, David J. Allen, Pietro G. Coen, Annette Jeanes, Zisis Kozlakidis, Lesley Larkin, Fatima Wurie, Julie Robotham, Mark Jit, Sarah R. Deeny

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Background. Norovirus places a substantial burden on healthcare systems, arising from infected patients, disease outbreaks, beds kept unoccupied for infection control, and staff absences due to infection. In settings with high rates of bed occupancy, opportunity costs arise from patients who cannot be admitted due to beds being unavailable. With several treatments and vaccines against norovirus in development, quantifying the expected economic burden is timely. Methods. The number of inpatients with norovirus-associated gastroenteritis in England was modeled using infectious and noninfectious gastrointestinal Hospital Episode Statistics codes and laboratory reports of gastrointestinal pathogens collected at Public Health England. The excess length of stay from norovirus was estimated with a multistate model and local outbreak data. Unoccupied bed-days and staff absences were estimated from national outbreak surveillance. The burden was valued conventionally using accounting expenditures and wages, which we contrasted to the opportunity costs from forgone patients using a novel methodology. Results. Between July 2013 and June 2016, 17.7% (95% confidence interval [CI], 15.6%?21.6%) of primary and 23.8% (95% CI,20.6%?29.9%) of secondary gastrointestinal diagnoses were norovirus attributable. Annually, the estimated median 290 000 (interquartile range, 282 000?297 000) occupied and unoccupied bed-days used for norovirus displaced 57 800 patients. Conventional costs for the National Health Service reached 107.6 million; the economic burden approximated to 297.7 million and a loss of 6300 quality-adjusted life-years annually. Conclusions. In England, norovirus is now the second-largest contributor of the gastrointestinal hospital burden. With the projected impact being greater than previously estimated, improved capture of relevant opportunity costs seems imperative for diseases such as norovirus.

Original languageEnglish
Pages (from-to)693-700
Number of pages8
JournalClinical Infectious Diseases
Issue number5
Publication statusPublished - 16 Aug 2018

Bibliographical note

Funding Information:
Financial support. Z. K. was supported by the Health Innovation Challenge Fund grant ICONIC funded by the Department of Health and the Wellcome Trust (grant reference T5-344). F. W. was funded by a small grant from the Royal Free Charity. M. J. was supported by the NIHR Health Protection Research Unit (HPRU) in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with PHE (grant reference code HPRU-2012–10096). N. A. and D. J. A. are affiliated with the NIHR HPRU in Gastrointestinal Infections at University of Liverpool in partnership with PHE, in collaboration with University of East Anglia, University of Oxford, and the Quadram Institute (grant reference code HPRU-2012– 10038). N. A. is based at PHE and the University of Liverpool. D. J. A. is based at the London School of Hygiene and Tropical Medicine and affiliated with PHE. Potential conflicts of interest. D. J. A. gave an invited presentation at an Infectious Disease Research Network meeting on norovirus in October 2014 that was supported by Takeda Pharmaceuticals. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Publisher Copyright:
© The Author(s) 2018.


  • burden of disease
  • gastroenteritis
  • norovirus
  • opportunity costs
  • outbreaks.


Dive into the research topics of 'Estimating the Hospital Burden of Norovirus-Associated Gastroenteritis in England and Its Opportunity Costs for Nonadmitted Patients'. Together they form a unique fingerprint.

Cite this